| NPI | 1710313358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MD H0081805) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: DC DO034597) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A14803) | |
| 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0102204572) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-09-14 |
| Last Update Date | 2021-05-31 |